From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Get an annual flu shot today. You can file the grievance yourself. A. Check out the Interoperability Page to learn more. Providers do not need to do anything additional to provide services on or after 4/1/2021 if the provider is in network with both WellCare and Absolute Total Care. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. Timely Filing Limit: Timely Filing Limit is the time frame set by insurance companies and provider has to submit health care claims to respective insurance company within the set time frame for reimbursement of the claims. WellCare is the health care plan that puts you in control. P.O. Authorizations already processed by WellCare for any services on or after April 1, 2021, will be moved to Absolute Total Care and there is no need for the provider or member to request these services again. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Because those authorizations will automatically transfer to Absolute Total Care, it is not necessary to request the authorization again when the member becomes eligible with Absolute Total Care. Only you or your authorizedrepresentative can ask for a State Fair Hearing. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. Copyright 2023 WellCare Health Plans, Inc. WellCare Non-Emergency Medical Transportation (NEMT) Update, Provider Self-Service Quick Reference Guide (PDF), Provider Masters Level Proposed Rates (PDF), Member Advisory Committee (MAC) Member Flyer (PDF), Member Advisory Committee (MAC) - LTSS Member Flyer (PDF), Managed Care PHP Member PCP Change Request Form (PDF), Provider Referral Form: LTSS Request for PCS Assessment (PDF). Want to receive your payments faster to improve cash flow? We encourage you to check the Medicaid Pre-Auth Check Tool in the For Providers section on the Absolute Total Care website at absolutetotalcare.com to ensure that you are accessing the most current Absolute Total Care authorization requirements for dates of service on or after 4/1/2021. State Health Plan State Claims P.O. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. 1096 0 obj
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Q. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . Providers do not need to do anything additional to provide services on or after April 1, 2021 if the provider is in network with both WellCare and Absolute Total Care. Q. Farmington, MO 63640-3821. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at atc_contracting@centene.com. People of all ages can be infected. 8h} \x p`03
1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` The member will be encouraged to establish care with a new in network primary care provider/specialist prior to the end of the transition/continuity of care period to review present treatment plan and coordinate the member's medical care. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? Our call centers, including the nurse advice line, are currently experiencing high volume. P.O. The benefit can be used to get more than 150 items - including vitamins, pain relievers, cold and allergy medicines, baby wipes, and diapers - at no cost . Download the free version of Adobe Reader. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. Q. the timely filing limits due to the provider being unaware of a beneficiary's coverage. If you are unable to view PDFs, please download Adobe Reader. You can get many of your Coronavirus-related questions answered here. Q. Absolute Total Care will utilize credentialing cycles from WellCare and Absolute Total Care so that providers will only need to credential once every three years. The annual flu vaccine helps prevent the flu. Learn more about how were supporting members and providers. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. You may file your second level grievance review within 30 days of receiving your grievance decision letter. Forgot Your Password? You can get many of your Coronavirus-related questions answered here. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare primary care provider as if the primary care provideris in network with Absolute Total Care. You may request a State Fair Hearing at this address: South Carolina Department of Health We will send you another letter with our decision within 90 days or sooner. A. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. Claim Filing AmeriHealth Caritas North Carolina, hereafter referred to as the Plan (where appropriate), is required by the North Carolina and federal regulations to capture specific data regarding services rendered to its members. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. Members who are dealing with stress or anxiety can call our 24-Hour Behavioral Health Crisis Line at 1-833-207-4240 to speak with a trained professional. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. S< In South Carolina, WellCare and Absolute Total Care are joining to better serve you. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Wellcare uses cookies. At WellCare, we value everything you do to deliver quality care to our members your patients and ensure they have a positive health care experience. A. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. N .7$* P!70 *I;Rox3
] LS~. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. You will need Adobe Reader to open PDFs on this site. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) Awagandakami A. Providers can begin requesting prior authorization for pharmacy services from Absolute Total Care for dates of service on or after 4/1/2021 from Absolute Total Care on April 1, 2021. A. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. * Password. If you think you might have been exposed, contact a doctor immediately. Columbia, SC 29202-8206. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. WellCare Medicare members are not affected by this change. You will need Adobe Reader to open PDFs on this site. Tampa, FL 33631-3384. It was a smart move. Timely Filing Limits for all Insurances updated (2023) - Bcbsproviderphonenumber Timely Filing Limits for all Insurances updated (2023) One of the common and popular denials is passed the timely filing limit. Wellcare uses cookies. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Keep yourself informed about Coronavirus (COVID-19.) To continue providing transition of care services, providers that are not part of the Absolute Total Care network must agree to work with Absolute Total Care and accept Absolute Total Cares payment rates. Because those authorizations will automatically transfer to Absolute Total Care, it is not necessary to request the authorization again when the member becomes eligible with Absolute Total Care. Guides Filing Claims with WellCare. A. Addakam ditoy para kenka. To write us, send mail to: You can fax it too. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. That's why we provide tools and resources to help. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. These materials are for informational purposes only. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Call us to get this form. Providers are encouraged to visit the Provider Resources page at absolutetotalcare.com for manuals, forms and resources related to claims submission, eligibility, prior authorization and more. Wellcare uses cookies. What will happen to unresolved claims prior to the membership transfer? If you need claim filing assistance, please contact your provider advocate. Reimbursement Policies Prior authorizations issued by WellCare for dates of service on or after 4/1/2021 will transfer with the members eligibility to Absolute Total Care. Members will need to talk to their provider right away if they want to keep seeing him/her. We want to ensure that claims are handled as efficiently as possible. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. All transitioning Medicaid members will receive a welcome packet and new ID card from Absolute Total Care in March 2021 and will use the Absolute Total Care ID card to get prescriptions and access health care services starting April 1, 2021. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. You or your provider must call or fax us to ask for a fast appeal. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? 2023 Medicare and PDP Compare Plans and Enroll Now. Always verify timely filing requirements with the third party payor. A. You and the person you choose to represent you must sign the AOR form. The participating provider agreement with WellCare will remain in-place after 4/1/2021. Because those authorizations will automatically transfer to Absolute Total Care, it is not necessary to request the authorization again when the member becomes eligible with Absolute Total Care. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. Send your written appeal to: We must have your written consent before someone can file an appeal for you. Box 31224 The provider needs to contact Absolute Total Care to arrange continuing care. This person has all beneficiary rights and responsibilities during the appeal process. We may apply a 14 day extension to your grievance resolution. Please be sure to use the correct line of business prior authorization form for prior authorization requests. A. Please make sure you ask your members for a copy of their Absolute Total Care and Healthy Connections Choices Medicaid ID cards before each visit. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. The current transaction means that WellCare of South Carolina Medicaid members are transitioning to Absolute Total Care and will become Absolute Total Care members, effective April 1, 2021. For requests involving dates of service on April 1, 2021 and beyond, Absolute Total Care will follow Medicaid contract requirements allowing a 90-day transition of care period. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. Please use the Earliest From Date. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Please use the earliest From Date. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. hYnH~}9'I`@>cLq,&DYH"W~&eJx'"luWU]JDBFRJ!*SN(s'6# ^*dg4$SB7K4z:r6')baka+Raf4J=)l,
_/jaSpao69&&_Ln=?/{:,'z .1J0|~jv4[eUN{:-gl! K'&hng?y},&X/|OzcJ@0PhDiO})9RA9tG%=|rBhHBz7 Q. Wellcare Health Plans, Inc., complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We encourage you to check the Medicaid Pre-Auth Check Toolto ensure that you are accessing the most current Absolute Total Care authorization requirements for dates of service on or after April 1, 2021. Providers interested in joining the Absolute Total Care provider network should submit a request to the Network Development and Contracting Department via email at atc_contracting@centene.com. These grievances may be about: The state of South Carolina allows members to file a grievance at anytime from the event that caused the dissatisfaction. The participating provider agreement with WellCare will remain in-place after 4/1/2021. We understand that maintaining a healthy community starts with providing care to those who need it most. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Q. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. We will also send you a letter with our decision within 72 hours from receiving your appeal. Q. All transitioning Medicaid members will receive a welcome packet and new member ID card from Absolute Total Care in March 2021 and will use the Absolute Total Care ID card to get prescriptions and access healthcare services starting April 1, 2021. Members must have Medicaid to enroll. Providers will continue to work directly with WellCare to address any claims for dates of service prior to the membership transfer of April 1, 2021. Please use WellCare Payor ID 14163. We will call you with our decision if we decide you need a fast appeal. We must have your written permission before someone can file a grievance for you. You can ask in writing for a State Fair Hearing (hearing, for short). Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. P.O. We welcome Brokers who share our commitment to compliance and member satisfaction. 1071 0 obj
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Download the free version of Adobe Reader. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? Providers will continue to follow WellCares Medicaid policies and procedures for services provided to WellCare Medicaid members for dates of service prior to April 1, 2021. For requests involving dates of service on April 1, 2021 and beyond, Absolute Total Care will follow Medicaid contract requirements allowing a 90-day transition of care period. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. You now have access to a secure, quick way to electronically settle claims. A provider can act for a member in hearings with the member's written permission in advance. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40
b666q1(UtUJJ.i` (T/@E To continue care with their current provider after the 90-day transition of care, the provider must agree to work with Absolute Total Care on the member's care and accept Absolute Total Care's payment rates. Providers can begin requesting prior authorization from Absolute Total Care for dates of service on or after April 1, 2021 from Absolute Total Care on March 15, 2021. We expect this process to be seamless for our valued members, and there will be no break in their coverage. You will get a letter from us when any of these actions occur. Transition/continuity of care is an extended period of time members are given when they join or transfer to another plan in order to receive services from out-of-network providers and/or pharmacies, until that specified period ends. Payments mailed to providers are subject to USPS mailing timeframes. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. If at any time you need help filing one, call us. We are glad you joined our family! Box 31224 We expect this process to be seamless for our valued members and there will be no break in their coverage. There is a lot of insurance that follows different time frames for claim submission. How are WellCare Medicaid member authorizations being handled after April 1, 2021? Select Health Claims must be filed within 12 months from the date of service. All transitioning Medicaid members will receive a welcome packet and new ID card from Absolute Total Care in March 2021 and will use the Absolute Total Care ID card to get prescriptions and access healthcare services starting April 1, 2021. To earn rewards, members must: Download the Go365 for Humana Healthy Horizons app onto a mobile device from the Apple App Store or Google Play. You can ask for a State Fair Hearing after we make our appeal decision. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Refer to your particular provider type program chapter for clarification. To ask for hearing, call 1-800-763-9087 or write to: You also can make a request online using SCDHHS form at https://msp.scdhhs.gov/appeals/site-page/file-appeal. A. From time to time, Wellcare Health Plans reviews its reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS), and nationally recognized health and medical societies. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. Ambetter Timely Filing Limit of : 1) Initial Claims. We expect this process to be seamless for our valued members and there will be no break in their coverage. Will Absolute Total Care continue to offer Medicare and Marketplace products? Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. Our fax number is 1-866-201-0657. If you file a grievance or an appeal, we must be fair. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. We are proud to announce that WellCare is now part of the Centene Family. How do I bill a professional submission with services spanning before and after 04/01/2021? Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Copyright 2023 Wellcare Health Plans, Inc. Example of how to properly split claim that span the cutover date of April 1, 2021: Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. Box 600601 Columbia, SC 29260. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Will WellCare continue to offer current products or Medicare only? Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. R 1/70.3/Determining End Date of Timely Filing Period -- Receipt Date R 1/70.4/Determination of Untimely Filing and Resulting Actions R 1/70.5/Application to Special Claim Types R 1/70.6/Filing Claim Where General Time Limit Has Expired R 1/70.7/Exceptions Allowing Extension of Time Limit R 1/70.7.1/Administrative Error For additional information, questions or concerns, please contact your local Provider Network Management Representative. you have another option. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. For dates of service on or after April 1, 2021: Absolute Total Care Timely filing is when you file a claim within a payer-determined time limit. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. The way your providers or others act or treat you. We try to make filing claims with us as easy as possible. Providers can begin requesting prior authorization for pharmacy services from Absolute Total Care for dates of service on or after April 1, 2021 from Absolute Total Care on April 1, 2021. Claims Department Payments mailed to providers are subject to USPS mailing timeframes. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. PROVIDER REMINDER: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to 4/1/2021 if they are in the annual choice period. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 A hearing officer from the State will decide if we made the right decision. No, Absolute Total Care will continue to operate under the Absolute Total Care name. %PDF-1.6
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Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Providers are encouraged to visit the Provider Resources page at absolutetotalcare.com for manuals, forms and resources related to claims submission, eligibility, prior authorization and more. Symptoms are flu-like, including: Fever Coughing Example of how to properly split claim that span the cutover date of April 1, 2021: Q. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. Can I continue to see my current WellCare members? Prior authorizations issued by WellCare for dates of service on or after April 1, 2021 will transfer with the members eligibility to Absolute Total Care. hbbd``b`$= $ On June 19, 2018, the Family and Social Services Administration's ("FSSA") Indiana Health Coverage Programs ("IHCP") released provider bulletin BT201829 regarding revising the timely filing limit for Medicaid fee-for-service claims. We expect this process to be seamless for our valued members, and there will be no break in their coverage. A. A. For as long as your member has an active WellCare subscriber number, you should continue to submit claims directly to WellCare as you have in the past. Box 100605 Columbia, SC 29260. Finding a doctor is quick and easy. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. Member Appeals (Medical, Behavioral Health, and Pharmacy): Copyright 2023 Wellcare Health Plans, Inc. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. In this section, we will explain how you can tell us about these concerns/grievances. Q. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare Primary Care Physician (PCP) as if the PCP is in network with Absolute Total Care. $8v + Yu @bAD`K@8m.`:DPeV @l When you receive your notification of WellCares grievance resolution, and you are dissatisfied with the resolution regarding adverse decisions that affect your ability to receive benefits, access to care, access to services or payment for care of services, you may request a second level review with WellCare. Providers will continue to work directly with WellCare to address any claims for dates of service prior to the membership transfer of April 1, 2021. Q. Reconsideration or Claim Disputes/Appeals: It is called a "Notice of Adverse Benefit Determination" or "NABD." Do I need to do anything additional to provide services on or after 4/1/2021 if I am in network with both WellCare and Absolute Total Care? For dates of service on or after 4/1/2021: Professional and Institutional Fee-For-Service/Encounter EDI transactions should be submitted to Absolute Total Care Medicaid with Payer ID <68069> for Emdeon/WebMD/Payerpath or <4272> for Relay Health/McKesson. Wellcare uses cookies. 2) Reconsideration or Claim disputes/Appeals. The Medicare portion of the agreement will continue to function in its entirety as applicable. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices.
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